Tailoring Stress Cardiac MRI for Women with Ischemic Heart Disease

为患有缺血性心脏病的女性量身定制应激心脏 MRI

• 批准号: 10426232
• 负责人: Kim-Lien T Nguyen
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10426232
• 关键词: Accounting; Adenosine; Affect; Anatomy; Angiography; Biological Markers; Blood Vessels; Blood Volume; Blood capillaries; Blood flow; Cardiac; Cardiovascular Diseases; Cause of Death; Chest Pain; Chronic; Chronic Kidney Failure; Clinic; Clinical Management; Contrast Media; Coronary; Coronary Angiography; Coronary Stenosis; Coronary heart disease; Data; Defect; Detection; Development; Diagnosis; Diagnostic; Event; Exercise; Face; Female; Foundations; Frequencies; Gadolinium; Hand; Heart; Image; Injections; Intervention; Intravenous; Ionizing radiation; Iron; Iron deficiency anemia; Ischemia; Kidney; Kidney Diseases; Lung diseases; Magnetic Resonance; Magnetic Resonance Imaging; Mammary Gland Parenchyma; Measures; Medical; Metabolic; Microvascular Dysfunction; Modeling; Morphologic artifacts; Myocardial; Myocardial Ischemia; Myocardial tissue; Myocardium; Nephrogenic Systemic Fibrosis; Nuclear; Obesity; Patients; Pattern; Performance; Perfusion; Perfusion Weighted MRI; Persons; Pharmaceutical Preparations; Pre-Clinical Model; Property; Protocols documentation; Radiation; Recurrence; Reference Standards; Relaxation; Renal function; Resistance; Rest; Risk; Safety; Services; Signal Transduction; Stress; Stress Tests; Symptoms; Techniques; Testing; Therapeutic; Therapeutic Agents; Time; Tissues; Translating; Vascular blood supply; Vasodilation; Veterans; Veterans Health Administration; Woman; Work; attributable mortality; base; cardiac magnetic resonance imaging; common symptom; contrast enhanced; cost effective; data acquisition; diagnostic accuracy; diagnostic tool; disability; endothelial dysfunction; experience; ferumoxytol; grasp; imaging approach; indexing; iron deficiency; male; men; model design; porcine model; recruit; side effect; single photon emission computed tomography; superparamagnetism; tool; ultrasound

PROJECT ABSTRACT Chronic ischemic heart disease (IHD) is a $10.4-billion-dollar problem that is responsible for 45.1% of deaths attributable to cardiovascular disease. Compared to men, women have a different spectrum of IHD. Current diagnostic tools follow a one-size-fits-all model and are designed to detect a male pattern of IHD. Issues such as breast tissue, obesity, and lung disease render easily accessible tools such as ultrasound or nuclear SPECT imaging more limiting for women. Ischemia with no obstructive coronary disease is more common in women compared to men; symptomatic women face higher rates of major cardiac events than asymptomatic women. Therefore, accurate non-invasive tools that enable characterization of the entire spectrum of IHD and its correlative ischemic burden are crucial for clinical management of women with ischemic symptoms. Invasive interventions are without risks and lack of therapeutics contributes to disability. Myocardial ischemia occurs when there is an imbalance between metabolic demand and blood supply. Although tissue blood supply is affected by both myocardial blood flow (MBF) and myocardial blood volume (MBV), current stress perfusion strategies focus on measuring deficits in MBF, which alone may not reflect all aspects of myocardial ischemia. To better reflect the ischemic burden, we propose an MBV-based, whole-heart, gadolinium-free, non- nephrotoxic, ferumoxytol contrast-enhanced, cardiac magnetic resonance imaging (MRI) stress testing approach that will detect inducible ischemia. We build upon our experience in ferumoxytol-enhanced MRI and add rigor by testing our strategy in pre-clinical models of ischemia; we efficiently translate our approach to the clinic by validating the technique in women with IHD, some of whom require ferumoxytol for therapeutic purposes. Because 2 billion people worldwide have iron deficiency, the dual use of ferumoxytol as a diagnostic and therapeutic agent in the context of stress testing represents one approach to tailoring stress cardiac MRI for women who are frequently iron deficient. Successful completion of our project would result in a gadolinium- free, ferumoxytol-enhanced MRI stress testing approach that can reliably differentiate between normal vs ischemic myocardial tissue and would establish a foundation for development of myocardial stress testing approaches that enable interrogation of both epicardial and microvascular IHD.

项目摘要 慢性缺血性心脏病（IHD）是一个104亿美元的问题，造成45.1％的死亡 归因于心血管疾病。与男性相比，女性的IHD频谱不同。当前的 诊断工具遵循一个尺寸适合的模型，旨在检测IHD的男性模式。问题 作为乳房组织，肥胖和肺部疾病，易于获得的工具，例如超声或核能 SPECT对女性的限制更加限制。没有阻塞性冠状动脉疾病的缺血在 女人与男人相比；有症状的女性面临的主要心脏事件发生率要高于无症状 女性。因此，能够表征整个IHD和IHD的精确非侵入性工具 它的相关性缺血负担对于患有缺血性症状的女性的临床管理至关重要。侵入性 干预措施没有风险，缺乏治疗剂会导致残疾。心肌缺血发生 当代谢需求和血液供应之间存在不平衡时。尽管组织血液供应是 受心肌血流（MBF）和心肌血容量（MBV）的影响，当前应力灌注 策略专注于衡量MBF的缺陷，仅此功能可能无法反映心肌缺血的所有方面。 为了更好地反映缺血性负担，我们提出了一个基于MBV的全心，无gadolinium，非 - 肾毒性，铁氧基对比增强，心脏磁共振成像（MRI）应力测试 可以检测诱导性缺血的方法。我们基于我们在铁氧基增强的MRI和 通过在缺血前模型中测试我们的策略来增加严格的态度；我们有效地将我们的方法转化为 诊所通过验证IHD女性的技术，其中一些人需要铁氧毒醇进行治疗 目的。因为全球20亿人具有铁缺乏症，所以双重用作铁氧毒菌作为诊断 在压力测试的背景下，治疗剂代表一种调整应力心脏MRI的方法 对于经常脱铁的女性。成功完成我们的项目将导致gadolinium- 可以可靠地区分正常VS 缺血性心肌组织，并将为心肌应激测试的发展建立基础 可以审问心外膜和微血管IHD的方法。